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Health insurance open enrollment brings eye-popping increases for some, but not for all

Virginian-Pilot (Norfolk, VA)

Nov. 02--Sandra Edwards hadn't received her health insurance renewal letter yet, and so she decided to call her carrier to find out the 2018 rate.

The answer was eye-popping: Her premium is going from $680 to $977 a month next year, a 44 percent increase that's more than she can afford.

"It's not a political issue any more, it's a cost issue," said Edwards, a 62-year-old Franklin resident.

She falls into one of the categories most likely to be slammed by insurance increases this year: Someone who buys an individual health insurance plan but who doesn't qualify for tax credits or subsidies through the Affordable Care Act exchange, or what many call Obamacare.

Paula Howie, 60, of Norfolk, was worried after going online to look at individual health plans and seeing premiums that hovered in the $1,000-a-month range.

But when she went to a Celebrate Healthcare signup session on Wednesday, she discovered she qualified for a subsidy that brought her premium down to $362.

"I was stressed over nothing," she said. "I urge people to come talk to someone to get over the fear and anxiety."

Those two scenarios and everything in between are playing out across the region as the chatter about health insurance moves from the political arena to kitchen tables. Open enrollment for the Obamacare federal exchange began on Wednesday and will run through Dec. 15.

In a year when major insurers left or reduced their footprint on the individual exchange in the state, there's more reason than ever to do homework and ask for help.

Sharp premium increases will be the norm on the individual market for people who don't qualify for subsidies. Optima Health is the only carrier on the federal exchange in the Hampton Roads area, since Anthem pulled out of the 2018 exchange in many Virginia localities in August. Optima has an average premium increase in its individual health insurance plans of 81 percent; Anthem is covering the Eastern Shore and Southampton County and has an average increase of 54 percent.

However, people who qualify for cost-sharing reduction subsidies or tax credits -- about 80 percent of current Virginia ACA enrollees -- will have the blow softened, and in some cases, even be paying smaller premiums. President Trump announced in October the federal government would not be paying the subsidies, but insurers still must offer them, which is one reason they increased premiums. That move ended up lowering the cost for many people who qualify for help.

For instance, Kaiser Family Foundation calculated that a 40-year-old in Norfolk making $35,000 will be able to get the lowest-cost silver plan for $250 in 2018, a drop from this year's $263.

Edwards doesn't use the federal exchange, but buys an individual plan through Anthem. The increase is so high for next year, she's considering other options, such as faith-based group policies.

Mary Jo Lascara went online to look for insurance for her son, since he aged out of her policy at 26. His insurance is going from $200 to $364.

"I about fell out of my chair," she said. "I have to get it, but I'm thinking, 'Young people are not going to do this. They don't have the money.' "

Howie had been hearing all the rumblings about health insurance as well, so she started researching policies. Her husband, Mike, will soon be qualifying for Medicare, so she would no longer be on his employer-based insurance. He had retired a few years ago but qualified for insurance through his company until he reached Medicare age. This will be her first time looking for insurance on the federal insurance exchange.

She took to the internet to check some prices both on and off the exchange. Then, her phone started ringing off the hook with insurers pitching their wares. She and Mike headed to a signup session Wednesday at Norview Community Center in Norfolk to figure it all out.

Fortunately, she found out she qualifies for a subsidy, so her premiums are affordable. She said insurance shopping had been confusing up until that signup visit.

"I feel sorry for people who don't have anyone to help them or who don't have computers. It breaks my heart. We're in our 60s, we're smart people, and it's been overwhelming for us," Paula Howie said.

She's also frustrated by all the slick mailings she is receiving from insurance companies: "That money could be used to reduce the cost."

Janel Hofler, a self-employed accountant from Portsmouth, also qualifies for a subsidy and found a plan with a premium that was less than $1.

Jill Hanken, director of Enroll Virginia, offered these tips during a Kaiser Family Foundation session early this week leading up to open enrollment. Virginians need to watch for any mailings or email from the current insurers and from the federal government.

If they qualify for a cost-sharing-reduction subsidy, they need to buy a silver plan on the exchange. People who don't might do well to look at other tiers and also seek options off the exchange, in case there are cheaper options there. Some insurers increased silver plan premiums more to make up for potential loss of federal payments.

It's best to look at all the plans available instead of simply renewing a current plan because there may be plans that are less expensive. People need to weigh monthly premiums against deductibles and co-payments and figure out how often they go to the doctor to make the best decision.

Also, check to see if your doctors and other health-care providers accept the insurance you're considering, and whether your prescriptions are covered.

Most households that earn enough to owe federal income tax must have health insurance or pay a fine due with their taxes. The fine for not having insurance is the greater of $695 or 2.5 percent of the taxpayer's income. Some households can be exempt from this fine if they meet certain hardship exceptions.

This is also a common time for enrollment windows for employer-based insurance, so people are sorting through their options in that arena as well.

Mercer's 2017 National Survey of Employer-Sponsored Health Plans was released Thursday and found that the average employee contribution amount for an employee-only coverage this year was $153 monthly for a preferred provider organization plan, $125 for a health maintenance organization plan and $90 for a consumer-driven plan with a health savings account.

Mercer's survey of 101 Virginia companies found that they expect to hold their cost increase to 3.6 percent in 2018 by making changes to plan design and vendors.